Provider Demographics
NPI:1457563066
Name:LAWHON, JAMES MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:LAWHON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5225
Mailing Address - Country:US
Mailing Address - Phone:843-669-7044
Mailing Address - Fax:843-669-7052
Practice Address - Street 1:230 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5225
Practice Address - Country:US
Practice Address - Phone:843-669-7044
Practice Address - Fax:843-669-7052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3407Medicaid
SCZX3407Medicaid
SCU823320281Medicare UPIN